Incorrect instrument counts

You should complete an incident report form, and risk identification form (if they are different things at your facility). The tech is completely out of line for being mad at you for an incorrect count, and for bringing it to the attention of the surgeon. The surgeon has a right to know, so does anesthesia and every other member of that team. An incorrect count is not something you should attempt to cover up. As far as I am concerned an over count is just as disturbing as an undercount. If you don't actually know what the count is, then what is the point of even counting? How would you know at the end of the case whether you were actually over by 2 instruments, or whether there were actually 4 instruments excluded from the original count? If the number of instruments counted is incorrect, then it is simply a bad count. Had I been the nurse in this room, I would have not only asked for a visual inspection of the cavity, but an X-ray to be done before the patient left the room.

The lax attitude of this facility is going to get them into trouble, and the tech should be disciplined (or at least spoken to about her attitude). Before people start jumping up and down about nurses beating on techs I am a card carrying CST as well as a BSN. Personally, in this situation I would write up the tech and the nurse who did the original count. It simply isn't good enough that they both missed those instruments and then expected someone else to cover their mistake by not bringing it to the attention of the surgeon. Bad form people, just really bad form.

Stay strong in instances like this one and do the right thing for the patient. It's one thing being a team player, but covering for someone else's incompetence should not be part of being a team player.

Even if the count sheet was incorrect that should have been caught during the initial count. Your scrub tech was out of line for being angry when one of her main responsibilities is to ensure a correct count.

At my facility an incorrect count requires an X-ray before the patient leaves the table. I think you should be hard nosed when it comes to the counts. You might hear grumbling now but that's nothing compared to what you would feel if anything was left in the patient.

Read your policy for that facility and I honestly would have asked for an X-ray and then write out an incident report and immediately talk to the director. I write up scrubs that don't like doing counts. Remember in a court of a law you will have to answer for your decisions and actions. Your license and your livelihood...even if it ****** anyone off you must do right by your patient ultimately. I know so many nurses who were non-chalant about instrument counts and one in which an instrument was left in for 5 months who now has to go to court and explain themselves. ALWAYS do what is right.

That scrub tech was out of line and your preceptor should have backed you up and covered everything with you that you're supposed to do in a situation like that. I've seen a lot of people who were too lax because we had too many of something at the end, and I would call the shots and tell the surgeons we had to get an x-ray due to policy. I'm not taking any chances that something else was missed in our initial count. To me, a wrong count is a wrong count. Sure, my surgeons would get ticked sometimes, but they knew exactly why it needed to be done and they always liked working with me because they knew I did a good job taking care of that patient. I've also run into the occasional tech who would get mad at me because I demanded another count. For some odd reason, some of these people think we only need to do one closing count, even on an open belly case. Any time someone would give me crap about it, I went straight to my supervisor as soon as the case was done. They can get mad all the want, but they need to do their job.